To the Editor:-Ravindran presented a method for monitoring the electrocardiograph (ECG) in patients with extensive burns in whom it is difficult to monitor the ECG because of the lack of natural skin and the application of protective ointments that prevent the adherence of the ECG pads. [1]We present another option.

A pacing esophageal stethoscope (Model 250 used in conjunction with the Model 3 preamplifier and the Model 7A pulse generator, Arzco Medical Systems, Inc., Tampa, FL*) permits the recording of atrial and ventricular electrograms in addition to transesophageal atrial pacing. The electrogram will usually provide sufficient information for rate and rhythm monitoring, but it is not useful for ischemia monitoring.

Potential advantages of this system compared to Ravindran's suggestion are that it is not invasive nor painful. In patients in whom there is a dysrhythmia, atrial electrograms can be superior to surface ECGs for diagnosing dysrhythmias. [2]Additionally, it provides a method for antibradycardia or antitachycardia atrial pacing should it become necessary. [3]However, a limitation of the pacing esophageal stethoscope is that it needs to be placed after endotracheal intubation and removed before extubation; hence this ECG is not available during induction nor emergence. However, 4- and 10-French catheters that are compatible with the above-mentioned pulse generator and preamplifier and which can be inserted into and maintained in an awake patient are available (Arzco Medical Systems, Inc.); hence these electrograms can be used pre-, intra-, and postoperatively. Another limitation of this suggestion is that it cannot be used in patients in whom esophageal instrumentation is contraindicated (e.g., those with dysphagia, esophageal web or diverticulum, esophageal stenosis or stricture, radiation injury, or recent esophageal surgery).

I hope this information is helpful for the care of these patients.

Jonathan V. Roth, M.D.

Department of Anesthesiology; Albert Einstein Medical Center; 5501 Old York Road; Philadelphia, Pennsylvania 19141

(Accepted for publication January 20, 1998.)

*Dr. Roth is on the Medical Advisory Board of Arzco Medical Systems, Inc., Tampa, Florida.

Ravindran RS: A solution to monitoring the electrocardiograph in patients with extensive burn injury. Anesthesiology 1997; 87(3):711-2.
Waldo AL, MacLean WAH: Diagnosis of cardiac arrhythmias following open heart surgery, Diagnosis and Treatment of Cardiac Arrhythmias following Open Heart Surgery Emphasis on the Use of Atrial and Ventricular Epicardial Wire Electrodes. Mount Kisco, New York, Futura Publishing Company, 1983, pp 45-114.
Roth JV: Transesophageal pacing and recording: An update. Prog Anesth 1996; X(22):431-48.